A short report: survey of practice nurses' attitudes towards giving smoking cessation advice

BACKGROUND: Although practice nurses play an important role in implementing smoking cessation strategies in primary care, relatively little is known of their attitudes and beliefs about giving smoking cessation advice. OBJECTIVES: To describe practice nurses' attitudes towards giving smoking cessation advice. METHODS: 152 of 200 (76%) practice nurses randomly selected from Medical Research Council General Practice Research Framework records completed a postal survey. The Attitudes to Smoking Cessation Advice Questionnaire was used. RESULTS: Overall, nurses were enthusiastic about giving smoking cessation advice and perceived such advice as effective. Nurses who were non-smokers perceived such advice as more effective than current smokers, as did those who had been trained in smoking cessation, who were also more enthusiastic than those who had not been trained. CONCLUSION: Training all practice nurses in smoking cessation, and offering nurses who smoke effective smoking cessation services, is likely to help achieve Government targets for smoking cessation.     

2016-2018年上海市戒烟门诊患者干预效果分析

【目的】了解上海市戒烟门诊就诊患者的一般情况、吸烟情况、戒烟情况以及1个月随访情况,为进一步有效开展戒烟门诊提供科学依据。【方法】调查2016年1月1日-2018年12月31日前往项目选定戒烟门诊就诊的841名吸烟者,并于1个月后完成725名患者的随访工作,利用SPSS软件分析收集到的相关数据。【结果】2018年就诊患者中91.3%为男性;50.6%年龄在35~55岁;57.1%学历程度在小学及以下;60.2%是企业,商业,服务业工作人员。44.1%的患者每天吸烟支数在10~20支;34.6%的患者烟龄在10~20年;38.6%的患者起床后5 min内吸第1支烟。72.1%的患者在前往戒烟门诊前尝试过戒烟;14.8%的患者使用过电子烟帮助戒烟;33.9%知晓戒烟门诊的途径是本医院医生的告知;61.4%决定戒烟的原因是关注自己和家人的健康。2018年戒烟门诊1个月的时点戒烟率为48.8%;44.0%的患者认为对戒烟帮助最大的关键是自己的决心;46.2%戒烟未成功患者认为,最大的阻碍是烟瘾发作。【结论】上海市戒烟门诊的开设能够帮助患者戒烟,但依然存在一些问题。针对前往戒烟门诊的患者特点,应及时找出戒烟门诊宣传上的薄弱点,例如女性、低文化水平以及务农职业的患者较少;依据患者吸烟的情况,切实提升戒烟门诊服务质量;找出戒烟门诊在提供再次戒烟服务过程中的切入点,更好地完善上海市戒烟门诊的建设工作。     

Barriers experienced by nurses providing smoking cessation support to disadvantaged,young women during and after pregnancy

In Europe, smoking during and after pregnancy is still highly prevalent among socioeconomically disadvantaged women. Nurses caring for these women can play a key role in smoking cessation, but encounter many problems when providing support. This research aims to identify barriers in providing smoking cessation support, experienced by nurses working within a Dutch preventive care programme for disadvantaged young women (VoorZorg), and to understand the underlying reasons of these barriers. Sixteen semi‐structured interviews with nurses were performed. All interviews were recorded, transcribed and analysed deductively and inductively. We found that the VoorZorg programme provided nurses with training, resources and time to deliver smoking cessation support. Yet, nurses experienced important barriers, such as unmotivated clients and support methods that do not fit clients’ needs. Underlying reasons are competing care demands, unsatisfactory training for cessation support, lack of self‐efficacy in attending their clients, and conflicts with own professional attitudes. The results emphasise that nurses’ ability to provide smoking cessation support could be improved by proper training in interventions that fit their clients’ needs, and by time schedules and task definitions that help them to prioritise smoking cessation support over other matters.     

北京市某三甲医院医务人员吸烟状况及控烟态度和简短戒烟干预情况

目的 了解北京市某三甲医院创建无烟医院十余年后医务人员的吸烟状况及控烟态度和临床医务人员简短戒烟干预情况,为今后医务人员控烟干预提供参考依据.方法 于2017年7月采用整群抽样方法在北京市某三甲医院抽取2 141名在职医务人员进行问卷调查.结果 北京市某三甲医院调查的2 141名医务人员中,吸烟者49人,吸烟率为2.3...     

Older patients in the acute care setting: rural and metropolitan nurses' knowledge, attitudes and practices

ABSTRACT: Many studies reporting nurses' knowledge of and attitudes toward older patients in long-term care settings have used instruments designed for older people. However, nurses' attitudes toward older patients are not as positive as their attitudes toward older people. Few studies investigate acute care nurses' knowledge of and attitudes toward older patients. In order to address these shortcomings, a self-report questionnaire was developed to determine nurses' knowledge of, and attitudes and practices toward, older patients in both rural and metropolitan acute care settings. Rural nurses were more knowledgeable about older patients' activities during hospitalisation, the likelihood of them developing postoperative complications and the improbability of their reporting incontinence. Rural nurses also reported more positive practices regarding pain management and restraint usage. However, metropolitan nurses reported more positive attitudes toward sleeping medications, decision making, discharge planning and the benefits of acute gerontological units, and were more knowledgeable about older patients' bowel changes in the acute care setting.     

Knowledge, attitudes and practices regarding smoking cessation among Chinese affiliates of women's organisations in Hong Kong

Volunteers and staff of women's organisations who are highly active in engaging and providing community service can be recruited to motivate female smokers to quit. We described the knowledge and attitudes regarding tobacco control and smoking cessation among these affiliates in Hong Kong and identified factors associated with the practices of cessation interventions. Eight of 14 women's organisations joining the Women Against Tobacco Taskforce agreed to participate. All staff, volunteers, and members of the eight organisations were invited to complete a self-administered anonymous questionnaire during July and August 2006. A total of 623 out of 771 (80.8%) affiliates responded. Their knowledge on smoking and health (mean = 3.91, SD = 1.44 on a range of 0-7), smoking related diseases (mean = 2.91, SD = 0.97 on a range of 0-4), and women-specific diseases (mean = 2.93, SD = 1.87 on a range of 0-6), was considered to be inadequate. They had positive attitudes towards tobacco control (mean = 3.31, SD = 0.55) and their own role in smoking cessation counselling (mean = 3.19, SD = 0.56) on a 4-point Likert scale and 39.3% reported had attempted to offer quitting advice. Logistic regression analysis found that participants having direct contact with smokers who had a positive attitude towards their own role in smoking cessation counselling (OR = 2.57; 95% CI = 1.67-3.95) and better knowledge of smoking and smoking-related diseases (OR = 1.35; 95% CI = 1.06-1.71) were more likely to provide cessation counselling after controlling for gender; knowledge on smoking and health, and women-specific diseases; attitude towards tobacco control, negative and positive attitudes towards female smokers, and perceived self-efficacy in smoking cessation counselling. Women's organisations showed limited support towards tobacco control and their affiliates had a limited knowledge on smoking and health but had positive attitudes. Appropriate training, capacity building and establishing rapport with women's organisations are needed to promote smoking cessation and to support tobacco control in the community.     

深圳市公立医院戒烟门诊状况调查

目的 了解广东省深圳市各医疗卫生机构戒烟门诊设置及运作情况。方法 采用普查方法,利用统一自制调查问卷对深圳市全部59家公立医院进行调查,有效问卷56份。结果 深圳市公立医院戒烟门诊设有率为78.57%,未开设的原因主要是医护人员不足（45.45%）。戒烟门诊挂靠在呼吸内科居多（55.81%）;戒烟门诊开设时间主要是全天（58.93%）;仅有 1家三级医院对戒烟门诊医务人员进行补贴;戒烟门诊每周平均服务时间为22.3 h。戒烟门诊人员配置以医生为主,主要为兼职人员（89.29%）,有23家医院没有配备护理人员（45.10%）。一氧化碳检测仪（6.89%）和体重计（51.16%）保有率偏低;宣传教育材料保有率以宣传折页（76.74%）最高,器官模型和影像资料最低（11.63%）。过去1个月每个门诊平均接诊68人,其中二级医院最多,为97人;服务对象主要是门诊病人（81.82%）和医院工作人员（70.45%）;服务类型面谈辅导（100%）较高,而电话辅导（34.09%）较低;仅有9.09%的戒烟门诊能够提供药物治疗。共有12家医院（占27.27%）收费,其中只有1家医院可完全由医保支付。结论 戒烟门诊运行存在配置不全和政策支持不足等诸多困难,政府部门应出台相应的戒烟服务优惠政策,增加医务人员戒烟服务补贴,将戒烟药物纳入医保支付,开展综合性的戒烟干预方能有效提高戒烟门诊就诊率和戒烟成功率。     

吸烟归因遗传认知与戒烟成功关系

目的 探讨吸烟归因遗传认知与戒烟成功的关系,为制定控烟干预措施提供理论依据。方法 采用以社区人群为基础的病例对照研究,对山东省17个行政村中≥18岁男性居民进行现况调查,以其中642名戒烟成功者为病例组,700名戒烟失败者为对照组,分析吸烟归因遗传认知与戒烟成功的关系,并评价吸烟归因遗传认知对拒烟自我效能及尼古丁依赖的影响。结果 在调整年龄、文化程度、婚姻状况等潜在混杂因素后,吸烟归因遗传认知阳性对戒烟成功有显著的负性影响(OR=0.642,95%CI=0.479~0.859);吸烟归因遗传认知阳性者与阴性者比较,吸烟归因遗传认知阳性者积极情境拒烟自我效能、消极情境拒烟自我效能、习惯情境拒烟自我效能得分和拒烟自我效能总分分别为(2.397±0.023)、(2.319±0.030)、(3.060±0.026)和(2.592±0.022)分,均低于吸烟归因遗传认知阴性者的(2.730±0.051)、(2.812±0.065)、(3.615±0.058)和(3.052±0.049)分,尼古丁依赖得分为(3.447±0.080)分,高于吸烟归因遗传认知阴性者的(2.168±0.174)分(均P<0.001)。结论 吸烟归因遗传认知是戒烟成功的危险因素,并可降低吸烟者知觉控制水平。     

成都市城市居民吸烟、被动吸烟及成功戒烟现状调查

目的了解四川省成都市城市居民吸烟、被动吸烟及成功戒烟现状, 为制定新的控烟措施提供参考依据。方法采用整群随机抽样方法对在成都市6个主城区抽取的4 994名18~69周岁城市居民进行问卷调查。结果成都市城市居民的吸烟率为25.31%(1 264/4 994),被动吸烟率为48.78%(1 482/3 038),成功戒烟率为10.65%(107/1 005);成都市不同特征城市居民比较, 不同性别、年龄、文化程度、职业城市居民吸烟率、被动吸烟率、成功戒烟率差异均有统计学意义(均P<0.001)。结论成都市居民的吸烟率较低, 但被动吸烟率较高, 且成功戒烟率不高。     

Cigarette smoking: knowledge, attitudes and behaviour in an adult population in Italy

The study explores knowledge, attitudes, and behaviour regarding cigarette smoking and related factors in an adult population. A total of 935 parents of children attending the eighth class of ten randomly selected primary schools in Catanzaro (Italy) received a questionnaire consisting of questions on demographic and socioeconomic characteristics, knowledge, behaviour and attitudes about cigarette smoking. Six hundred and sixty-nine parents returned the questionnaire, with a response rate of 71.5%. Knowledge of risk associated to smoking was significantly higher in more educated subjects and in past smokers compared to current. Current and past smokers were respectively 39.6% and 17.2%, and current smokers were younger, not married, less prone to consider smoking as a major risk for their health and more likely to live with other smokers compared to past and never smokers. Females of higher education were more likely to be current smokers, whereas male current smokers were more likely to be less educated compared to past or never smokers. The results strongly recommend the provision of accurate information about the health consequences related to smoking, with a more intensive involvement of health care providers, particularly targeted to women and younger age groups.     

The Effectiveness of a Directly Mailed Smoking Cessation Intervention to Australian Discharged Hospital Patients

Background. The objective was to assess the effectiveness of a directly mailed smoking cessation intervention to discharged hospital patients.Methods. A randomized controlled trial was used. In the 2 weeks after discharge, smokers in the intervention group were sent by mail a personally addressed letter from their medical consultant urging them to quit plus a self-help quitting manual, and smokers in the control group received usual care. Patients were surveyed about their smoking status at 6 and 12 months after discharge. A total of 1858 discharged patients responded to both questionnaires. The main outcome measures were self-reported smoking in past week at 6 and 12 months after discharge. Quitters at 12 months were biochemically tested for evidence of smoking.Results. The results failed to show that smoking cessation advice directly mailed to a broad cross-section of discharged hospital patients who smoke led to smoking cessation. However, the intervention increased cessation among smokers with medical conditions for which quitting is highly relevant. In general, patients who were more likely to quit were older, had entered the hospital as an emergency case, and had a medical diagnosis for which quitting is highly relevant.Conclusions. This study suggests that hospital patients who smoke and are also diagnosed with conditions which call for quitting are more likely to quit if they receive from their consultant a personalized letter advising them to quit and a self-help manual.     

漳州市不同人群吸烟现状及知识态度调查

目的了解福建省漳州市居民吸烟现状及吸烟危害知识以及对公共场所禁烟态度。方法在医疗、教育、机关、餐馆/公共汽车站候车室/网吧4类机构和场所随机抽取911名人员进行面对面问卷调查。结果吸烟216人,吸烟率为23.71%,其中,医疗机构人员吸烟率为19.81%(63/318),教育机构为18.86%(66/350)、机关为34.38%(22/64),餐馆/公共汽车站候车室/网吧为36.31%(65/179)。被动吸烟538人,总暴露率59.06%;人群知晓吸烟会危害吸烟者健康的比例>95%,而知晓吸烟会给被动吸烟者健康造成危害比例则<90%,对被动吸烟造成的健康危害知哓率则更低。结论餐馆/公共汽车站候车室/网吧等场所吸烟率和被动吸烟暴露率均高于其他机构,而对吸烟知识知晓率和对公共场所禁烟支持率却低于其他机构。     

Smoking behavior,initiating and cessation factors among Japanese nurses: a cohort study

The prevalence of smoking among Japanese nurses, specially in their twenties, is higher than that among the general female population. To examine smoking behavior, smoking initiating and cessation factors, we conducted a cohort study through questionnaire survey, targeting nurses (n=1572) working at 11 hospitals located in Tokyo metropolitan area. The first survey was conducted using a confidential questionnaire on smoking, followed by a second survey conducted in the same manner on the same subjects two years later. As to smoking status after two years, 8% (95%CI=1.5%) started smoking and 6% (95%CI=1.4%) quitted resulting in a 2% increase in the prevalence of current smoking. The average nicotine dependence for nurses who were smokers in the two surveys rose from 3.9 to 4.3 (P<0.05). Smoking behavior of mother, friends, or superiors at work had a significant influence on smoking behavior of nurses. As to smoking cessation factors, the idea that women and medical workers should not smoke, and living with family each had a significant influence. Considering the fact that 6% of nurses in this study succeeded in quitting smoking within two years, it is required that anti-smoking education be conducted at medical institutions to decrease the prevalence of current smoking among the nurses in Japan.     

江西省2013年成年人吸烟与戒烟行为现状调查

目的 调查2013年江西省≥18岁常住居民吸烟与戒烟行为的流行状况。方法 2013年7-10月采用多阶段分层整群随机抽样方法,在江西省10个全国慢性病及其危险因素监测点抽取≥18岁常住居民6 000人,通过面对面问卷调查收集慢性病相关危险因素信息,用于吸烟与戒烟行为分析的有效样本量为5 997人。对样本进行复杂加权后,分析江西省不同人群特征成年居民吸烟和戒烟流行现状。结果 2013年江西省≥18岁常住居民现在吸烟率为21.53%（1 291/5 997,标化率为20.60%）,复杂加权计算后,现在吸烟率为26.07%（95%CI：23.48%~28.66%）,男性现在吸烟率（50.62%,95%CI：46.31%~54.94%）高于女性（1.46%,95%CI：0.57%~2.35%）,差异有统计学意义（P<0.05）,各年龄组人群现在吸烟率差异有统计学意义（P=0.029）,并随文化程度提高而上升（P<0.05）、随自报健康状况下降而下降（P<0.05）。87.16%（95%CI：83.29%~91.03%）的现在吸烟者每日吸烟;日均吸烟量（机制卷烟）为19.27（95%CI：17.69~20.85）支;平均每天吸烟量≥20支的吸烟者比例为64.74%（95%CI：55.79%~73.70%）;每日吸烟者开始吸烟平均年龄为20.28（95%CI：19.74~20.82）岁,男性开始每日吸烟年龄[20.11（95%CI：19.61~20.61）岁]小于女性[26.88（95%CI：24.73~29.03）岁],差异有统计学意义（P<0.05）,27.04%（95%CI：18.91%~35.16%）的成年男性开始每日吸烟年龄不足18岁。吸烟者戒烟率为14.80%（95%CI：10.88%~18.72%）,随年龄增大而上升（P<0.05）、随收入水平增加而上升（P=0.04）,随自报健康状况下降而上升（P<0.05）;吸烟者成功戒烟率为10.89%（95%CI：8.36%~13.42%）;32.10%（95%CI：21.95%~42.25%）的现在吸烟者有戒烟打算。被动吸烟率为54.71%（95%CI：44.20%~65.21%）。结论 江西省≥18岁常住居民吸烟率处于较高水平,重度吸烟者比例大,戒烟者比例低,戒烟意识不强,男性和青少年为控烟工作主要目标人群,应根据江西省流行特点采取针对性的控烟措施。     

Smoking habits, exposure to passive smoking and attitudes to a non-smoking policy among hospital staff

A survey was carried out into the smoking habits and exposure to passive smoking among health staff in the hospitals of Faenza, Forli and Rimini (Emilia-Romagna, Northern Italy). 2453 subjects answered anonymously a 41 question questionnaire. 53% of the subjects were professional nurses, 16% doctors, 15% maintenance staff, 10% ancillary staff, 1% non-medical graduates, 2% were administrators and 3% were assigned to the category ‘others’.Of the subjects answering the questionnaire 39% were smokers, 19% ex-smokers and 42% non smokers. The highest number of smokers was found among women (41%) compared to men (37%) and among ancillary staff (48%) compared to nurses (41%) and doctors (31%). The males were mostly heavy smokers (≥20 cigarettes/d) and smoked strong cigarettes (≥12 mg/cig condensate content). The females were mostly light smokers (<10 cigarettes/d) and smoked light cigarettes (1–6 mg/cig condensate content). A high percentage of subjects (87%) smoked at work especially in areas reserved for staff. 43% and 26% of shift workers and non-shift workers tended not to modify their habit when on morning or afternoon shifts. During night shifts the majority of them increased their tobacco consumption.Around 87% of hospital employees stated they were exposed to passive smoking inside the hospital especially in cooking areas, at information desks and corridors. Nurses, ancillaries and maintenance staff were those most exposed and for a greater number of hours per day compared to doctors. Almost all subjects were aware of the harm caused by passive smoking. 56% of smokers, 65% of ex-smokers and 72% of non smokers said they were willing to participate in future campaigns to limit smoking in their hospitals.     

Work stress, smoking habits and competence in supporting clients to cease smoking--a survey among Finnish nurses

This paper describes results of a survey of Finnish nurses (n=882), their views of themselves as employees, their experiences of work stress and their competence to guide clients in smoking cessation. Nurses' skills to guide clients were fairly good but they had a lack of knowledge of smoking cessation centers and nicotine substitutions. The more positive the nurses' views were of themselves as employees, and the less they had experienced work stress related to their clients, the better they evaluated their skills and knowledge to guide clients to cease smoking. The results can be used to develop nurse education by providing a stronger knowledge base of smoking cessation. Nurses' view of themselves as employees could be strengthened by providing them with positive feedback from colleagues and managers.     

中学教师吸烟行为、知识和态度调查

目的了解中学教师吸烟行为以及与吸烟相关的健康知识和态度的关系。方法用自行设计的问卷对广州市黄埔区全体初中教师进行调查,内容包括一般情况、吸烟行为、吸烟相关的健康知识和态度。结果被调查的700名初中教师中从未吸烟者占59·1%,以前尝试吸烟者占18·1%,以前每日吸烟者占1·86%,现吸烟者占10·1%。在总分为14分的吸烟相关健康知识调查中,平均得分为8·53分,其中“吸烟可以引起的疾病”5·73分(满分10),“烟草中的有害成分”2·40分(满分4)。吸烟相关的态度平均得分,“吸烟的交际作用”33·21分(满分45),“吸烟的形象作用”21·76分(满分25),“教师与医务人员对吸烟的表率作用”20·96分(满分25),“吸烟危害健康”9·20分(满分10),“控烟措施”26·73分(满分30)。不同吸烟行为教师之间吸烟相关的健康知识得分差异无统计学意义,但是吸烟相关的态度得分差异有统计学意义。结论中学教师不同吸烟行为与吸烟相关的态度有关,而与吸烟相关的健康知识无关。     

吸烟和戒烟行为与男性2型糖尿病血糖控制关系的研究

目的 探讨男性2型糖尿病患者吸烟和戒烟行为与血糖控制的关系。方法 2013年12月至2014年1月,采用整群随机抽样方法,对江苏省常熟市、淮安市清河区和淮安区纳入国家基本公共卫生服务管理的7 763名男性2型糖尿病患者进行问卷调查和体格测量,并检测FPG和糖化血红蛋白（HbA1c）。采用多元线性回归模型分析吸烟和戒烟行为与血糖控制的关系。结果 男性2型糖尿病患者现在吸烟率为45.5%。随着吸烟量的增加,FPG和HbA1c水平均呈现上升趋势（P<0.001）。在药物治疗的糖尿病患者中,吸烟年限≥ 50年者和吸烟指数≥ 40包年者的HbA1c水平分别升高0.27%（95% CI：0.05%~0.49%）和0.38%（95% CI：0.23%~0.53%）,戒烟者随着戒烟年限的增加,其FPG和HbA1c水平呈下降趋势（P<0.05）。在非药物治疗的糖尿病患者中,吸烟和戒烟年限与FPG及HbA1c水平均未发现剂量反应关系。结论 吸烟不利于糖尿病患者血糖的控制,尤其是药物治疗的患者。戒烟有利于血糖控制,应鼓励和帮助吸烟患者及早戒烟。     

深圳市宝安区2020年居民烟草流行状况及吸烟与戒烟意愿的影响因素分析

目的 分析深圳市宝安区居民烟草流行情况及吸烟与戒烟意愿的影响因素,为相关部门有针对性地制定控烟策略、开展控烟工作提供依据。 方法 2020年4月,采用随机抽样的方法,在宝安区居民中进行吸烟、烟草危害知晓情况等的电子问卷调查,调查数据采用SPSS 22.0软件进行统计分析。 结果 宝安区居民总吸烟率为24.52%,现在吸烟率为18.99%。有戒烟意愿居民占60.62%,戒烟成功率为25.79%。非吸烟居民中被动吸烟率为64.98%。单因素及多因素logistic回归分析结果显示,性别为女性(OR=12.705,95%CI:9.600～16.814)、年龄≥45岁(OR=1.489,95%CI:1.242～1.785)、文化程度较高(OR=1.169,95%CI:1.046～1.307)、BMI较低(OR=0.681,95%CI:0.535～0.866)、未患慢性病(OR=4.359,95%CI:3.129～6.073)、过去一个月没有看到或听到香烟品牌宣传(OR=1.797,95%CI:1.406～2.292)的居民吸烟的可能性更小。年龄＜45岁(OR=2.705,95%CI:1.127～6.493)、有锻炼习惯(OR=1.948,95%CI:1.050～3.615)、看病时得到医生戒烟意见(OR=4.773,95%CI:2.643～8.620)、支持烟草税收提高(OR=2.838,95%CI:1.435～5.611)的吸烟者戒烟的意愿更大。 结论 宝安区居民总吸烟率和现在吸烟率位于全国较低水平,被动吸烟率较高,应将男性、低龄、文化程度较低作为控烟教育重点人群,同时加大戒烟宣传力度,增加医生劝诫率。     

The dissemination of a smoking cessation program: predictors of program awareness, adoption and maintenance

A self-report survey was used to collect data 18 months afterthe dissemination of a smoking cessation program to 23 antenatalclinics. Sixty-six percent of clinic staff (n = 187) completedand returned the survey. The study uses regression modelingto examine the relationship between organizational characteristics,individual clinician characteristics and methods of disseminationon program awareness, adoption, implementation/maintenance andchange in clinician smoking cessation intervention (SCI). Theresults indicated that participation in decision-making, workingin a clinic at the time of the initial program dissemination,professional status and dissemination method were significantpredictors of all stages of the dissemination process. Structuralvariables, e.g. policy, formalization of rules and organizationalcomplexity, influenced early dissemination processes, e.g. awarenessand adoption. Perceived hospital innovativeness and the degreeto which smoking intervention was used in a clinic prior todissemination were associated with program adoption. Clinicianself-efficacy was associated with program maintenance and improvedsmoking cessation intervention.